PUJ Obstruction (Pelvi-Ureteric Junction Obstruction)

It is a blockage or narrowing between the kidney pelvis and the ureter. PUJO impairs drainage of urine and this causes the urine to remain collected in the kidney causing swelling (Hydronephrosis). If it increases progressively then it causes back pressure on kidneys and subsequently affects the renal functions and may lead to a nonfunctioning kidney.

About 1 in 1500 children have PUJ obstruction from birth (congenital). PUJ obstruction is one of the conditions that can cause hydronephrosis, which is the most common condition found on prenatal ultrasound.Sometimes there aren’t any outward symptoms of PUJ obstruction and it is only found when an ultrasound shows that the kidneys are swollen. This is called hydronephrosis. Some children may experience back or side (flank) pain, or a urinary tract infection (UTI). The diagnosis of PUJ obstruction is confirmed by a study called a DTPA scan. A DTPA scan shows how well the kidneys are working and also about the severity of blockage.

The treatment for a PUJ obstruction depends on severity of the blockage. Blockages that are mild, appear to be stable or are improving over time are monitored with ultrasound. If the blockage is severe or worsening, it can cause permanent kidney damage and these require surgery to remove the portion of the blocked ureter. This surgery is called as pyeloplasty and is the procedure of choice for PUJ obstruction. The surgery involves removing the PUJ obstruction and joining the kidney onto the ureter (pyeloplasty). It has good results. This can be acheived through a traditional surgery (‘open pyeloplasty’) or by keyhole surgery (‘laparoscopic pyeloplasty’).

The child needs to stay in the hospital for 1 to 2 days and then is called after 3 days for removal of the dressing. A tube called stent is placed in the ureter at the time of surgery to keep the ureter open and draining while it heals. Stents are temporary and need to be removed after 4-6 weeks after the surgery. Removing the stent is a day care surgery and is removed with a scope passed through the urethra into the bladder.

Dr. Ashish Prasad

Consultant Paediatric Surgery and Paediatric Urology
MBBS, DNB (General Surgery), DNB (Paediatric Surgery)

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